THE DA VINCI SURGICAL SYSTEM By: Gianna Morrongiello

What is it? TELEMANIPULATION SURGICAL SYSTEM THAT CONSISTS OF AN ERGONOMICALLY DESIGNED SURGEON'S CONSOLE, A PATIENT CART WITH FOUR INTERACTIVE ROBOTIC ARMS, A HIGH- PERFORMANCE VISION SYSTEM AND PATENTED ENDOWRIST INSTRUMENTS. HAS BEEN USED IN MINIMALLY INVASIVE SURGERIES SINCE JUNE 2001 CAN PERFORM SURGERY THROUGH ONE OR A FEW 1-2 CM INCISIONS ( SIMILAR TO LAPAROSCOPIC SURGERIES) MINIATURIZED WRISTED INSTRUMENTS AND A HIGH-DEFINITION 3D CAMERA TRANSLATE YOUR SURGEON'S HAND MOVEMENTS INTO PRECISE MICRO-MOVEMENTS OF THE DA VINCI INSTRUMENTS PROVIDE SURGEONS WITH ENHANCED CAPABILITIES, INCLUDING HIGH DEFINITION 3D VISION AND A MAGNIFIED VIEW. CANNOT ACT ON ITS OWN. THE DOCTOR CONTROLS 100% OF THE DA VINCI SYSTEM REUSABLE 10 TIMES ONLY "Features." Da Vinci Surgery. Web. 24 Oct surgery/da-vinci-surgical-system/features.php

O PERATING ROOM SCHEMATIC [4] "Da Vinci Instruments." Intuitive Surgical. Web. 24 Oct nstruments_images.html

O PERATIVE FIELD VIEW [4] C OMPARISON WITH A PENCIL ERASER. [4] I NTUITIVE HAND MOTION CONTROLS "Da Vinci Instruments." Intuitive Surgical. Web. 24 Oct nstruments_images.html

Methods 128 PATIENTS OPERATED ON WITH THE DA VINCI™ ROBOTIC SYSTEM 78 FEMALE, 50 MALE PATIENTS MEAN AGE WAS 52 (RANGE 18–78) SURGERIES PERFORMED BY SIX DIFFERENT SURGEONS WHO WERE EXPERIENCED LAPAROSCOPISTS (EACH WITH TRAINING WITH THE DA VINCI SYSTEM) F IRST STUDY (T ESTING THE DA V INCI R OBOT ) : S ECOND STUDY (C OMPARING THE ROBOT WITH TRADITIONAL NON EVASIVE SURGERY ) : A SYSTEMATIC LITERATURE SEARCH WAS PERFORMED INDEPENDENTLY BY TWO OF THE AUTHORS PARTICIPANTS OF ANY AGE AND SEX WHO UNDERWENT ROBOTIC OR LAPAROSCOPIC LIVER RESECTION FOR ALL TYPE OF HEPATIC LESIONS WERE CONSIDERED DATA WAS RETRACTED Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct

122 OF 128 PROCEDURES (95%) WERE SUCCESSFULLY COMPLETED WITH THE DA VINCI™ ROBOT. (OPEN CONVERSION WAS NECESSARY IN FOUR CASES POSING SURGICAL PROBLEMS) THERE WAS NO RELEVANT (>50 ML) BLOOD LOSS IN ANY PROCEDURE. 30-DAY MORTALITY IN ALL 128 PATIENTS WAS 0%. THE ROBOTIC APPROACH IS SIGNIFICANTLY MORE EXPENSIVE THAN CONVENTIONAL MINIMALLY INVASIVE SURGERY, DUE TO LONGER PROCEDURE DURATION Results: F IRST STUDY (T ESTING THE DA V INCI R OBOT ) : S ECOND STUDY (C OMPARING THE ROBOT WITH TRADITIONAL NON EVASIVE SURGERY ) : LAPAROSCOPIC HAD A SIGNIFICANT REDUCTION IN BLOOD LOSS AND LOWER OPERATIVE TIME NO DIFFERENCES WERE FOUND WITH RESPECT TO CONVERSION RATE, R1 RESECTION RATE, MORBIDITY, OR HOSPITAL STAY. BOTH SHOWED SAFETY AND EFFECTIVENESS Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct

[2] P ROCEDURAL COST ( DOLLARS ) D URATION OF PROCEDURE ( MINUTES ) [2] [3] F UNNEL PLOT OF MORBIDITY (A) AND HOSPITAL STAY (B) IN ALL INCLUDED STUDIES. Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct

Why is this important? FURTHER SYSTEM DEVELOPMENT AS WELL AS A DRASTIC REDUCTION OF COSTS. “HYBRID OPERATIONS”- PROCEDURE WOULD BE DONE AS TRADITIONAL MINIMALLY INVASIVE SURGERY AND THE ROBOT WOULD BE USED ONLY FOR MOST CHALLENGING PARTS OF THE OPERATION, IN ORDER TO INCREASE EFFICIENCY AND DECREASE HUMAN ERROR IMAGE FUSION- RADIOLOGIC IMAGING SYSTEMS PERMITS MORE PRECISE AND DETAILED SURGICAL PLANNING SO THE SURGEON CAN MORE EASILY DETECT AND IDENTIFY HIDDEN ANATOMICAL STRUCTURES SURGICAL TRAINING PROGRAMS- SURGEONS IN TRAINING WILL PERFORM OPERATIONS ON PATIENTS ONLY AFTER PERFORMING THEM SUCCESSFULLY IN VIRTUAL REALITY ON THE DA VINCI SYSTEM Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct

Resources [1] “Features”. Intuitive Surgical Intuitive Surgical, Inc. Web. 24 Oct system/features.php. [2] Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct [3] Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct [4] “da Vinci instruments”. Intuitive Surgical Intuitive Surgical, Inc. Web. 24 Oct es.html.